Comparison of Inflammatory Response during on-pump and off-pump Coronary Artery Bypass Surgery-Reference-Cited by-同舟云学术

Comparison of Inflammatory Response during on-pump and off-pump Coronary Artery Bypass Surgery

Published:2010-03 Issue:3 Volume:33 Page:131-138
ISSN:0391-3988
Container-title:The International Journal of Artificial Organs
language:en
Short-container-title:Int J Artif Organs

Author:

Rimmelé Thomas¹,Venkataraman Ramesh¹,Madden Nicholas J.¹,Elder Michele M.¹,Wei Lawrence M.²,Pellegrini Ronald V.²,Kellum John A.¹

Affiliation:

1. The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA - USA

2. Division of Cardio-thoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA - USA

Abstract

Purpose On-pump coronary artery bypass graft (CABG) surgery has been traditionally associated with a higher magnitude of inflammatory response than off-pump CABG. However, with the development of polymer-coated biocompatible extracorporeal circuits, we wanted to see if cardiopulmonary bypass still played an important role in triggering this inflammatory response. Methods In this prospective observational study, 33 patients undergoing CABG surgeries (25 on-pump and 8 off-pump patients) were studied. Serial plasma cytokine (TNF, IL-6, IL-10) and procalcitonin concentrations were measured at different time-points during and after the surgery. Demographic and baseline clinical data, intra-operative management details and post-operative complications were also collected from the patients' charts. Results Plasma levels of all 4 mediators increased during surgery and returned towards normal post-operatively. There were no differences between groups for any mediator at any time-point. Conclusions We conclude that with the use of recent polymer-coated biocompatible extracorporeal circuits, the inflammatory response triggered by on-pump CABG becomes very similar in magnitude and pattern to that triggered by off-pump CABG. Thus, the surgical procedure contributes to most of the inflammatory response, with the extra-corporeal circuit having minimal to no effect on this response.

Publisher

SAGE Publications

Subject

Biomedical Engineering,Biomaterials,General Medicine,Medicine (miscellaneous),Bioengineering

Link

http://journals.sagepub.com/doi/pdf/10.1177/039139881003300301

Reference34 articles.

1. Inflammatory response to cardiac surgery: cardiopulmonary bypass versus non-cardiopulmonary bypass surgery

2. Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass

3. Endothelial Cell Injury in Cardiovascular Surgery: The Systemic Inflammatory Response11Recent discoveries in the field of vascular biology have led to an expanded understanding of the pathogenesis of many of the immediate and long-term complications of patients undergoing cardiovascular operations and interventional cardiologic procedures. In particular, the vascular endothelium has emerged as the central focus of many of the biologic events that affect the preoperative, operative, and postoperative course of nearly all heart surgery patients. A recurring theme in the study of endothelial cell biology is the crucial role that endothelial cell injury plays in the difficulties that our patients encounter. The deleterious effects of endothelial cell injury are most evident in the acute syndromes of vasospasm, coagulopathy, ischemia/reperfusion injury, and the systemic inflammatory response to cardiopulmonary bypass. In addition, chronic endothelial cell injury contributes to the development of anastomotic narrowing and the progression of atherosclerosis, both of which limit the long-term success of coronary artery bypass grafting. Because of the increasingly recognized role of the endothelium in cardiovascular function there is a tremendous amount of basic science information detailing the response of the endothelium to injury. This is the fifth in a series of seven reviews intended as an introduction to the major topics of endothelial cell biology that are of importance to the practicing cardiothoracic surgeon. In particular, the authors have focused on the role that the endothelium has on the development of vasomotor dysfunction, bleeding and thrombosis, neutrophil-endothelial cell interaction, and obstructive arteriopathy. The aim of these reviews is to provide a concise reference point for cardiothoracic surgeons as they evaluate the ever-accumulating research findings and new therapies that stem from the study of the endothelium in response to the insults encountered in cardiothoracic surgery.Edward D. Verrier, MD

4. Impact of Off-Pump Coronary Artery Bypass Surgery on Systemic Inflammation: Current Best Available Evidence

5. Does Off-pump Coronary Artery Bypass Reduce Mortality, Morbidity, and Resource Utilization When Compared with Conventional Coronary Artery Bypass? A Meta-analysis of Randomized Trials

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